Provider Demographics
NPI:1578605945
Name:GREIG, SALLY D (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:D
Last Name:GREIG
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CAMDEN DR
Mailing Address - Street 2:117
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4410
Mailing Address - Country:US
Mailing Address - Phone:310-569-1305
Mailing Address - Fax:310-273-8024
Practice Address - Street 1:415 NORTH CAMDEN
Practice Address - Street 2:117
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-569-1305
Practice Address - Fax:310-273-8024
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16161103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578605945OtherPTAN:BS168A